A connection between migraine occurrences and the presence of other mental health disorders like anxiety and depression has been established in several studies. Studies have shown that depression impacts as many as 80% of people suffering from migraines while other studies indicate that migraine symptoms were reported in roughly 67% of people who experienced anxiety disorders. It is uncertain if migraines are the cause of the mental health disorder or if the mental health disorders are the cause of migraines. This is largely due to studies that have shown instances where people who are afflicted by migraines eventually suffer from mental health disorders due to reduced quality of life and other studies that have shown mental health disorders that have led to migraine like symptoms due to some other underlying reason that tie the 2 comorbidities together. Understanding migraines and how they can impact the emergence and severity of anxiety and depression, and vice versa, can help individuals find the right treatment to improve quality of life and potentially address and eliminate one or both comorbidities.
What is a Migraine?
A migraine is typically identified by severe pain that impacts one or both sides of the head and is usually felt around the temples or behind the eyes or ears. This pain is usually accompanied by a sensitivity to light and sound and in some more extreme cases, nausea and vomiting. Symptoms will generally last between a few hours to several days at a time and the onset of a migraine is sometimes identified with visual symptoms called aura. Migraines with aura typically include sensory disturbances like blind spots, flashing lights, and other slight visual changes.
Impacts of Migraines
Migraines are more painful than a typical headache and chronic migraines can lead to a reduced quality of life if left untreated. Experiencing migraines regularly can have a negative impact on an individual’s ability to maintain their well being and lifestyle. Some psychosocial problems that arise due to experiencing migraines include:
- Problems maintaining mental and physical health
- Difficulty with work
- Inability to maintain social functioning
- Reduced vitality
- Difficulty addressing new and existing emotional problems
- Chronic pain
What is the Link Between Migraines and Mental Health Disorders?
The link between migraines and certain mental health disorders like anxiety and depression has been established but it has yet to be determined if migraines can cause anxiety and depression, or vice versa. That being said, there are generally several categories of explanation for the existence of the different comorbidities impacting an individual simultaneously.
- A unidirectional causal relationship that identifies one comorbidity directly causing another while the relationship would not work in the opposite direction. For example: migraines lead to depression, but depression does not lead to migraines.
- A bidirectional causal relationship that identifies a cyclical pattern of cause and effect between the different comorbidities. For example: migraines can cause depression which can lead to more migraines.
- Migraines and other comorbidities being caused by a common environmental risk factor. For example: a head injury leads to both migraines and psychological changes including anxiety and depression.
- Migraines and other comorbidities being caused by a shared genetic risk factor. For example: the genetic makeup of an individual’s parents who suffer from chronic migraines and mental health comorbidities increase an individual’s likelihood of suffering from the same problems.
- Other biological, environmental, or genetic risk factors combine to increase the likelihood of migraines and mental illness. For example: individuals who suffer from stress, insomnia, hormone imbalance, and serotonergic dysfunction may be more predisposed to migraines and mental health issues.
With the above considerations in mind, linking the cause and effect between migraines and mental illness is still difficult to determine since the link between the comorbidities is difficult to generalize. For many individuals the occurrence of chronic migraines leads to a lower quality of life which in turn results in the emergence of depression and anxiety months to years down the line. Other individuals live with depression and anxiety for some time before migraines are felt. Studies indicate that individuals that suffer from migraines, anxiety, or depression often experienced stress resulting from these issues. This may contribute to the emergence of medical and psychological comorbidities as stress may play a key role in the cyclical relationship of the different ailments. Other studies indicate that anxiety has a stronger correlation to increased migraine risk while dealing with migraine symptoms can lead to physical symptoms of depression. These connections create a cyclical pattern where worry leads to stress which triggers migraines which in turn increase the likelihood of depressive tendencies.
Migraines and Anxiety
Research has indicated that there is a strong link between anxiety and migraines. Roughly half of patients with migraine symptoms will also meet the criteria for an anxiety disorder at some point in their lifetime. Anxiety disorders are typically 2 – 5x more common in patients that suffer from migraines. Common symptoms of general anxiety disorder (GAD) including excessive worry, fear, and irritability which often coincide with migraine symptoms. Studies have shown that there is a bidirectional causal relationship between the comorbidities as anxiety can sometimes lead to migraines and vice versa. When an individual suffers from chronic migraines, anxiety may be felt because that individual worries about when the next migraine may onset, how severe it may be, and how it will impact their day-to-day activities. Other times, anxiety may onset first, with excessive worry and fear eventually leading to migraine symptoms due to changes in sleep patterns and eating and drinking habits.
Migraines and Depression
Depression and migraines have one of the strongest relationships when it comes to psychiatric comorbidities. Several studies show that migraine sufferers are 2.5x more likely to experience depression compared to individuals who are migraine free. The relationship between migraines and depression also seems to be a bidirectional causal relationship due to migraines being prompted by depression and vice versa. Similar to anxiety’s impact on migraines, symptoms of depression like changes in eating and sleeping habits can have a large impact on the onset of migraines. On the other hand, migraines can also drastically reduce the quality of life which can lead to severe depression. Luckily, the efficacy of tricyclic antidepressants on depression also works well to treat migraines. That being said, the efficacy of antidepressants as a migraine treatment suggests that the two comorbidities share similar triggers.
Other Mental Health Issues Associated with Migraines
Anxiety and depression are some of the more prominent comorbidities that occur with migraines, but they are not the only ones to present themselves. Migraines have been linked to several other psychological problems like bipolar spectrum disorder and PTSD.
Migraines and Bipolar Spectrum Disorder
The relationship between bipolar spectrum disorder and migraines also appears to have a bidirectional causal relationship. Individuals that suffer from migraines are 3x more likely suffer from bipolar disorder while one third of individuals that suffer from bipolar disorder also experience migraines. Since bipolar disorder is typically caused by genetics and / or biological differences in how the brain operates, migraines are likely a common symptom that is shared by those inflicted with bipolar disorder. Similar to the other mental health issues, bipolar disorders are often exacerbated by high levels of stress which can also trigger the onset of migraines.
Migraines and PTSD
Migraines are common in individuals who have suffered from trauma, abuse, and neglect. The connection between post traumatic stress disorder and migraines is still being explored but individuals that experience PTSD are said to have maladaptive stress responses which are thought to trigger or impact the onset of migraines.
Treatment Options
Treatment options exist for individuals who experience migraines with mental health comorbidities. There are medications and therapies that are effective but having migraines with other mental health comorbidities can make diagnosis more complicated.
Medications for Migraines with Anxiety and Depression
The existence of migraines with mental health comorbidities can lead to unique challenges for doctors when trying to provide medications. This can impact:
- Receiving the correct diagnosis which in turn impacts the type and amount of medication
- Understanding how certain medications should be prescribed
- Potentially over medicating or mixing medications with adverse effects
That being said, the choice of medication in patients that show migraine and psychiatric comorbidities should be based on the severity of symptoms, patient’s preference, patient’s risk for adverse effects, and prior treatment attempts. If symptoms of comorbidity are not severe, then some treatments may alleviate the symptoms of both ailments without the need to treat both comorbidities individually. However, if symptoms are severe, then separate medications may be needed to effectively treat both psychiatric comorbidities.
Migraines with other mental health comorbidities are often treated with abortive medications like triptans and NSAIDs (non-steroidal anti-inflammatory drugs) which are designed to stop symptoms of migraines. For individuals who experience chronic comorbidity symptoms, preventative medications like antidepressants, antihypertensives, and antiepileptic drugs may also be recommended. One class of antidepressants that have shown to be effective against migraines and the other psychiatric comorbidities are serotonin reuptake inhibitors (SSRIs). SSRIs are approved as a depression medication that also shows effectiveness in managing anxiety and migraine symptoms. Another class of antidepressants that have shown effectiveness in preventing migraines and managing other comorbidity symptoms are tricyclic antidepressants.
Therapies for Migraines with Anxiety and Depression
In addition to medications, there are different nonpharmacological therapies that have shown effectiveness in managing stress levels which is a trigger for migraines and instances of anxiety and depression.
Cognitive behavioral therapy helps individuals learn how to manage stress which can greatly reduce the onset of an anxiety attack or migraine. Similarly, relaxation therapies also help train the body and mind to react to stressors which can in turn reduce the likelihood of experiencing stress related migraines and anxiety attacks. Using biofeedback combined with deep breathing and learning different coping skills can also greatly reduce an individual’s stress response. The combination of the different therapies with medication has shown to be extremely effective when trying to treat for migraines with anxiety and depression.
Lifestyle Changes That Can Reduce Both Migraines and Mental Health Problems
The final thing that can significantly reduce the likelihood of migraines with anxiety or depression is to change poor lifestyle habits that exacerbate symptoms. Eating healthy, getting enough sleep, exercising, meditating, practicing self-care, reducing caffeine, and eliminating drugs or alcohol can all improve the frequency and intensity of migraines and other psychiatric comorbidities.
Impacts of Sleep on Migraines, Anxiety, and Depression
Sleep disorders can also have an overall negative impact on migraines, anxiety, and depression. People that experience migraines are much more likely to suffer from sleep disorders with chronic migraine sufferers being twice as likely to suffer from insomnia. The relationship between sleep disorders and migraine symptoms is also a bidirectional causal relationship because migraines can be caused by lack of sleep and the inability to sleep can be caused by migraines.
Migraines and Mental Health Comorbidities
Overall, psychiatric comorbidities present themselves in patients with migraines at a much higher rate than those that are migraine free. The reason behind this link is still not well understood but the presence of these mental health comorbidities increases the risk of chronic migraines, reduce the quality of life of migraine sufferers, and make treatment more complicated.
Schedule a Consultation with an Experienced Migraine Doctor to Discuss Any Migraine and Mental Health Issues
If you are suffering from migraines as well as anxiety or depression, it is critical to see someone that has the experience necessary to diagnose your problem accurately and suggest an effective treatment method. Dr Kathy Omrani at the Headache TMJ Los Angeles Pain Clinic has served as an orofacial pain specialist who focuses on diagnosing and treating migraines and other types of headaches. Be sure to call today to schedule a consultation!
Migraine and Mental Health FAQs
Can migraines be caused by depression?
Depression and migraines have a bidirectional causal relationship that indicates that migraines could be caused by depression or that depression could be caused by migraines.
Can stress and depression cause migraines?
Stress has been determined to be an exacerbating factor for both depression and migraines. While it may not be a direct cause, it can trigger the onset of migraine and depression symptoms.
Can migraines be caused by anxiety?
Anxiety can also be the cause or the result of migraines. Similar to depression, anxiety and migraines have a bidirectional causal relationship.
